Squamous Cell Carcinoma of Eyelid, Periocular, and Periorbital Skin

Abstract

Squamous cell carcinoma (SCC) is an invasive epithelial malignancy derived from epidermal keratinocytes and is the second most common eyelid and periocular skin malignancy, after basal cell carcinoma, comprising 5% to 10% of eyelid and periorbital skin malignancies 1-3 (Fig. 1). The Australian age standardized incidence in 2002 was 387 cases/100,000/y. 4 Extrinsic risk factors include ultraviolet (UV) light/ actinic damage, radiation, arsenic, hydrocarbons, and immunosuppressive drugs. Diets rich in fats (full cream milk, dairy products) are associated with a higher incidence of SCC, whereas high intake of leafy green vegetables is protective. 5,6 Intrinsic risk factors include fair skin and red/blond hair, organ transplantation, immunosuppression, chronic skin lesions, albinism, and genodermatoses such as xeroderma pigmentosum and epidermodysplasia verruciformis (Fig. 2). SCCs occur most commonly in the sixth to seventh decades and are more common in men than women (2 to 3:1). There have been a number of series and recent reviews of SCC of the eyelid to which the reader is referred. 1,7-12 This review will concentrate on the pathogenesis, clinical biology, behaviour, and management of SCC. ' Pathogenesis and Clinical BiologySCC formation follows the multistage model of skin carcinogenesis in laboratory studies. UV damage leads to photomutagenesis with p53 clones forming in morphologically normal skin. Mutated p53 results in altered apoptosis and clonal proliferation of keratinocytes. 13 These can progress to actinic keratosis or regress, depending on exposure to further UV and/or to local immunosuppression factors. Once an actinic keratosis or papilloma has formed, it may regress or progress, again www.internat-ophthalmology.com | 17

Periorbital Mohs Reconstruction

“…[13][14][15] In our retrospective review, there were a higher percentage of females in both BCC (53%) and SCC (73%) subgroups. Furthermore, the rate of primary surgical complications was higher in females (27%) than in males (18%), but the difference was not statistically significant.…”

Acurácia da biópsia incisional por trépano de 2 mm nos tumores palpebrais: estudo comparativo entre um e dois sítios

“…Apresenta evolução mais rápida, eventualmente com ulceração. (8,17,24,(51)(52)(53)(54)(55) Acomete indivíduos mais idosos, após a sexta década de vida, mais homens que mulheres. Pessoas de pele clara com história de exposição solar crônica são mais suscetíveis, como no CBC.…”

“…(24, 51,52,54) A alteração causada pela radiação UV leva à fotomutagênese com clones p53, levando à apoptose alterada e proliferação clonal de ceratócitos.…”

“…(51,54) A Doença de Bowen se refere ao CEC in situ com atipia epidérmica de espessura total, porém sem acometimento da derme profunda à histopatologia. Apresenta-se como placa eritematosa crônica, elevada, arredondada ou ovalada.…”

“…A invasão orbitária direta tende a ocorrer em tumores de crescimento rápido ou negligenciados, com incidência de 6%. (51,54) Histologicamente, o CEC é classificado, conforme seu grau de diferenciação, em pouco, moderadamente ou bem diferenciado. …”